CMS rulings PDF
Preview CMS rulings
J-^^' f^^' r m %^^ -c^. 4 CMS Rulings Page of 1 CMS Home j;A&^«t CMS ! FAQs l-fmdkm€k jSf r; Search now '0 [Prcy1|i^ssj#ji^l;gJ€Qveyft<| O Media Center Programs ,/^ CMS hhW Rulings ^Medicare ^Medicaid 2oot|o^ *SCHIP Centers for Medicare & Medicaid Services Department of Health and Human Services *HIPAA *CLIA Centers for Medicare & Medicaid Services (CMS) Rulings are decisions of the Topics Administrator that serve as precedent final opinions and orders and ^Advisory statements of policy and interpretation. They provide clarification and Committees interpretation of complex or ambiguous provisions of the law or regulations -^Coverage relating to Medicare, Medicaid, Utilization and Quality Control Peer Review, ^Demonstrations private health insurance, and related matters. ^Manuals CMS Rulings are binding on all CMS components. Medicare contractors, the ^Medicare Provider Reimbursement Review Board, the Medicare Geographic Modernization Classification Review Board, and Administrative Law Judges (ALJs) of the Act Social Security Administration (SSA) who hear Medicare appeals. These T^New Freedom Rulings promote consistency in interpretation of policy and adjudication of ^Open Door disputes. Forums ^Oral Health ^Partner with CMS CMS Ruling 05-01^ * PRIT (54 kb) dated May 2005 1^Providers This Ruling sets forth CMS policy concerning the requirements for determining ^Quality payment for insertion of presbyopia-correcting intraocular lenses following Initiatives cataract surgery under the following sections of the Social Security Act (the "5^Quarterly Act): Provider Update • Section 1832(a)(2)(F) for services furnished in connection with surgical ^Regulations * procedures performed in an Ambulatory Surgical Center (ASC). State Waivers "^Statistics & • Section 1833(t)(l)(B)(iii) for implantable items described in paragraphs Data (3), (6), or (8) of section 1861(s) that are covered hospital outpatient department services. Resources "^Acronyms • Section 1861(s)(l) for physicians' services. ^Contacts A • Section 1861(s)(2)(A) for services and supplies furnished incident to a Events physician's professional service, of kinds which are commonly furnished *Forms in physicians' offices and are commonly either furnished without charge or included in the physicians' bills. ^Glossary ^Mailing Lists • Section 1861(s)(2)(B) for hospital services incident to physicians' ^Search http://www.cms.hhs.gov/rulings/ 10/20/2005 c CMS Rulings Page 2 of4 services furnished to outpatients. • Section 1861(s)(8) for one pair of conventional eyeglasses or contact lenses furnished subsequent to each cataract surgery with insertion of an intraocular lens. • Section 1862(a)(7) where notwithstanding any other provision of this title, no payment nnay be made under Medicare Part A or Part B for any expenses incurred for items or services where such expenses are for ... eyeglasses (other than eyewear described in section 1861(s)(8)) or eye examinations for the purpose of prescribing, fitting, or changing eyeglasses, procedures performed (during the course of any eye examination) to determine the refractive state of the eyes. CMS Ruling 02-01© (131 kb) dated October 2002 This CMS Ruling sets forth our policy regarding implementation of the new appeals provisions in section 1869 of the Social Security Act, as amended by section 521 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), Public Law 106-554. The Ruling identifies changes that take effect on October 1, 2002 and provides notice of the administrative procedures that CMS contractors, administrative law judges, and the Departmental Appeals Board are to follow in processing Medicare claims appeals. Ruling 01-01© (34 kb) dated September 2001 This Ruling states the CMS policy regarding the appropriate actions upon receipt of a complaint seeking review of a national or local coverage determination under section 522 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), Public Law 106-554. HCFA Ruling 98-1© (93 kb) dated December 1998 This Ruling states the policy of the Health Care Financing Administration regarding the appropriate administrative appeals process the Medicare carrier must pf-ovide to physicians, non-physician practitioners, and to certain entities that receive reassigned benefits from physicians and non-physician practitioners. This appeals process will be available to a physician or entity that (i) has received reassigned benefits; (ii) has been denied enrollment in the Medicare program or had Medicare billing privileges revoked; and (iii) is not eligible to use the appeals procedures in 42 CFR part 498. HCFA Ruling 97-2© (46 kb) dated February 1997 This Ruling states the policy of the Health Care Financing Administration concerning the determination to change its interpretation of section 1886(d) (5)(F)(vi)(II) of the Social Security Act (the Act) and 42 CFR 412.106(B)(4) to http://www.cms.hhs.gov/rulings/ 0/20/2005 1 CMS Rulings Page 3 of4 follow the holdings of the United States Courts of Appeals for the Fourth, Sixth, Eighth, and Ninth Circuits. Under the new interpretation, the Medicare disproportionate share adjustment under the hospital inpatient prospective payment system will be calculated to include all inpatient hospital days of service for patients who were eligible on that day for medical assistance under a State Medicaid plan in the Medicaid fraction, whether or not the hospital received payment for those inpatient hospital services. HCFA Ruling 97-l@ (68 kb) dated February 1997 This Ruling states the policy of the Health Care Financing Administration concerning the requirements for determining if Medicare payment will be made under the limitation on liability provision, section 1879 of the Social Security Act, to a provider, practitioner, or other supplier for partial hospitalization services for which Medicare payment is denied. HCFA Ruling 96-3@ (72 kb) dated December 1996 This Ruling states the existing policy of the Health Care Financing Administration concerning the requirements for determining if Medicare payment will be made under the limitation on liability provision, section 1879 of the Social Security Act, to a provider, practitioner, or other supplier for parenteral and enteral nutrition therapy, including intradialytic parenteral nutrition therapy, services and items for which Medicare payment is denied. This Ruling supplements HCFAR 95-1 with respect to section 1879(g) of the Act. HCFA Ruling 96-2@ (52 kb) dated November 1996 This Ruling states the policy of the Health Care Financing Administration concerning the requirements for determining if Medicare payment will be made under the limitation on liability provision, section 1879 of the Social Security Act, to a supplier, practitioner, or other supplier for pap smears and mammography services for which Medicare payment is denied. HCFA Ruling 96-l@ (64 kb) dated September 1996 This Ruling states the policy of the Health Care Financing Administration regarding the distinction between the statutory benefits of "orthotics" and "durable medical equipment" under Medicare Part B. The distinction may have an effect on the Medicare approved amount of payment and is necessary in those instances where items are furnished in skilled nursing facilities that meet the definition in section 1819(a)(1) of the Social Security Act (the Act) or hospitals due to the express exclusion from Part B coverage of durable medical equipment when used in a hospital or skilled nursing facility. The Ruling clarifies that the "orthotics" benefit in section 1861(s)(9) of the http://www.cms.hhs.gov/rulings/ 0/20/2005 1
The list of books you might like
